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I can't find it at the moment, but I recall seeing a report from China that 80% of COVID-19 patients placed on ventilators still ended up dying. I assume that's

I can't find it at the moment, but I recall seeing a report from China that 80% of COVID-19 patients placed on ventilators still ended up dying. I assume that's not the case in the US? (does anyone have stats on this yet?) I also recall seeing (again, can't find it right now) a scientist concerned about the potential for widespread usage of ventilators to rapidly increase the prevalence antibiotic resistant bacteria. My point is, having as many ventilators as we need is good, but it's even better to not need the ventilators in the first place. I hope we don't fixate on ventilators too much at the expense of mitigation and other treatments.

Green_man 7y ago
A doctor on the twiv podcast in America said that about 50% of his patients died after getting put on ventilators. https://podcasts.google.com/?feed=aHR0cDovL3R3aXYubWljcm9iZXdvcmxkLmxpYnN5bnByby5jb20vdHdpdg&episode=NDMwNzJlMTEtNjZjMy00Njk0LTlmMjctZDVmMmE5YWFkMmI5 https://podcasts.google.com/?feed=aHR0cDovL3R3aXYubWljcm9iZX... It's about 15-25 minutes in if you want to hear the full quote.
- bayesian_horse 7y ago
  That figure is meaningless because he can't account for the people who are still on a ventilator on the moment and will eventually die.
  - Green_man 7y ago
    yeah, I wish i had a study or something, but I happened to be listening to the podcast right when I saw the parent question. the guy was an immunologist iirc, so he has some statistical background. He probably was counting patients who either died or got off the ventilator, but I don't know for sure.
  - aidos 7y ago
    Presumably you can compare people who die vs those recover and no longer need the ventilator. The number that recover after being on a ventilator (for say, 2 weeks, or something) would seem to provide more information (though I suspect it may be a little harrowing to hear the number).
VectorLock 7y ago
>widespread usage of ventilators to rapidly increase the prevalence antibiotic resistant bacteria. I'm curious how that would work out. I think it would have to do with the drugs that are given along side the ventilator, not from the ventilator itself? >I hope we don't fixate on ventilators too much. It feels to me like we might be. It'll definitely be needed, but I think there are other issues that aren't getting as much attention; problems that might not seen as solvable by someone in their garage with a 3d printer and some pneumatic valves.
- baddox 7y ago
  I assume this is the issue: https://en.wikipedia.org/wiki/Ventilator-associated_pneumonia https://en.wikipedia.org/wiki/Ventilator-associated_pneumoni...
- bayesian_horse 7y ago
  From a quick overview I don't think VAP will be a more serious issue for the proposed device than the commercial ones. The microbes would come from two sources: Inside the system (from a prior patient), and from the air supply. The former can be mostly prevented by replacing the bag and the tracheal tube, because both are cheap and disposable. Then there are probably some connection pieces and those need to be sterilized or replaced between patients. The air supply can be run through a relatively low-tech filter if absolutely necessary.
  - tlrobinson 7y ago
    I think the concern was about the widespread use of ventilators in general, whether they are commercial or not.
  - VectorLock 7y ago
    I was under the impression these bag mask valves have a filter to prevent contamination from getting back in the bag but seems like its safe to just dispose, given adequate supply.
  - fock 7y ago
    cheap and disposable like the N95 masks? Does anyone manufacture these bags and tubes in your country at scale?
wl 7y ago
My partner has been treating COVID patients. The numbers she's seeing for COVID patients on ventilators surviving are better, but not by much.
- mikeyouse 7y ago
  Likewise. In SF at the moment, they're having pretty good outcomes but that's due to half-full ICUs and dedicated care. I could see how bad things would get if they were to be overwhelmed though.
- deleted 7y ago
  [deleted]
- KMag 7y ago
  As I'm sure you and she are aware, the gut-feel regression has a very poor historical track record at separating confounding variables, particularly outside of controlled studies. The decision to vent or not is being made by an expert physician, taking many variables into account, so it's very difficult to tease out a meaningful conclusion just by comparing the two survival rates.
deleted 7y ago
[deleted]
avsteele 7y ago
It is a small study out of China, but yes, the #'s here are not good. 19/22 patients (~85%) put on 'invasive mechanical ventilation' died (read:intubation) https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30110-7/fulltext https://www.thelancet.com/journals/lanres/article/PIIS2213-2...
nabla9 7y ago
The number of people dying on ventilators is not meaningful question because patient dying from COVID-19 almost always becomes critical before dying. If there is ventilator, they get hooked into them for a some time. The real question to ask is how many people who would survive with ventilator die without it.
- enchiridion 7y ago
  From a scientific perspective you are right. It is also important that people realize ventilators only have a moderate impact, and act accordingly.
- alkonaut 7y ago
  > because patient dying from COVID-19 almost always becomes critical before dying Actually I read the opposite. That the patients in ICU's are younger 40-70 with the bulk in their 60's, while those dying are mainly 75-100, mostly over 80 years old. That is: many if not most of those who die never pass the ICU. Obviously people in ICU wards die too, a significant fraction. But the age of the group that die mostly (80+) means it's mostly non-ICU patients. Doctors know a 80 year old with some comorbidity isn't going to survive being tubed. By "survive" they mean survive for X months afterwards too (This number can be e.g. 6 or 12 months to use as a guideline for survivability, to consider ICU treatment).
  - outworlder 7y ago
    This is what makes discussions on this subject infuriating. Most people only have access to the absolute death numbers, and yet try to draw conclusions from them. If it is the case, as you say, that a significant fraction of young people need to go into intensive care to have a chance to recover, that makes this pandemic much worse than most people think. I do know that the number of hospitalizations is high (and possibly should be higher still, if hospitals were not turning away patients)
    - IgorPartola 7y ago
      Then here are the numbers: https://www.statista.com/chart/amp/21173/hospitalization-icu-admission-and-fatality-rates-for-reported-coronavirus-cases/ https://www.statista.com/chart/amp/21173/hospitalization-icu... COVID-19 still requires very high hospitalization rates, even among young people.
notyourday 7y ago
At +1 year post ventilator survival rate is 30% pre-COVID19 https://www.ncbi.nlm.nih.gov/pubmed/8404197 https://www.ncbi.nlm.nih.gov/pubmed/8404197
- rladd 7y ago
  To be more exact, (in that study) the total percentage of patients who were initially put on the ventilator who survived for at least a year was 30%. Of the approximately 50% of patients who were on a ventilator and survived long enough to be released from the hospital, 60% of those survived for at least a year.
paulmd 7y ago
Yes. 86% globally, 70% from Seattle currently at the moment. Here's a report on the state of things from a New Orleans ER doctor: https://www.reddit.com/r/medicalschool/comments/fpwc1y/frontline_covid19_experience_in_new_orleans_er/ https://www.reddit.com/r/medicalschool/comments/fpwc1y/front...

Green_man 7y ago

A doctor on the twiv podcast in America said that about 50% of his patients died after getting put on ventilators. https://podcasts.google.com/?feed=aHR0cDovL3R3aXYubWljcm9iZXdvcmxkLmxpYnN5bnByby5jb20vdHdpdg&episode=NDMwNzJlMTEtNjZjMy00Njk0LTlmMjctZDVmMmE5YWFkMmI5 https://podcasts.google.com/?feed=aHR0cDovL3R3aXYubWljcm9iZX... It's about 15-25 minutes in if you want to hear the full quote.

bayesian_horse 7y ago
That figure is meaningless because he can't account for the people who are still on a ventilator on the moment and will eventually die.
- Green_man 7y ago
  yeah, I wish i had a study or something, but I happened to be listening to the podcast right when I saw the parent question. the guy was an immunologist iirc, so he has some statistical background. He probably was counting patients who either died or got off the ventilator, but I don't know for sure.
- aidos 7y ago
  Presumably you can compare people who die vs those recover and no longer need the ventilator. The number that recover after being on a ventilator (for say, 2 weeks, or something) would seem to provide more information (though I suspect it may be a little harrowing to hear the number).

VectorLock 7y ago

>widespread usage of ventilators to rapidly increase the prevalence antibiotic resistant bacteria. I'm curious how that would work out. I think it would have to do with the drugs that are given along side the ventilator, not from the ventilator itself? >I hope we don't fixate on ventilators too much. It feels to me like we might be. It'll definitely be needed, but I think there are other issues that aren't getting as much attention; problems that might not seen as solvable by someone in their garage with a 3d printer and some pneumatic valves.

baddox 7y ago
I assume this is the issue: https://en.wikipedia.org/wiki/Ventilator-associated_pneumonia https://en.wikipedia.org/wiki/Ventilator-associated_pneumoni...
bayesian_horse 7y ago
From a quick overview I don't think VAP will be a more serious issue for the proposed device than the commercial ones. The microbes would come from two sources: Inside the system (from a prior patient), and from the air supply. The former can be mostly prevented by replacing the bag and the tracheal tube, because both are cheap and disposable. Then there are probably some connection pieces and those need to be sterilized or replaced between patients. The air supply can be run through a relatively low-tech filter if absolutely necessary.
- tlrobinson 7y ago
  I think the concern was about the widespread use of ventilators in general, whether they are commercial or not.
- VectorLock 7y ago
  I was under the impression these bag mask valves have a filter to prevent contamination from getting back in the bag but seems like its safe to just dispose, given adequate supply.
- fock 7y ago
  cheap and disposable like the N95 masks? Does anyone manufacture these bags and tubes in your country at scale?

wl 7y ago

My partner has been treating COVID patients. The numbers she's seeing for COVID patients on ventilators surviving are better, but not by much.

mikeyouse 7y ago
Likewise. In SF at the moment, they're having pretty good outcomes but that's due to half-full ICUs and dedicated care. I could see how bad things would get if they were to be overwhelmed though.
deleted 7y ago
[deleted]
KMag 7y ago
As I'm sure you and she are aware, the gut-feel regression has a very poor historical track record at separating confounding variables, particularly outside of controlled studies. The decision to vent or not is being made by an expert physician, taking many variables into account, so it's very difficult to tease out a meaningful conclusion just by comparing the two survival rates.

deleted 7y ago

[deleted]

avsteele 7y ago

It is a small study out of China, but yes, the #'s here are not good. 19/22 patients (~85%) put on 'invasive mechanical ventilation' died (read:intubation) https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30110-7/fulltext https://www.thelancet.com/journals/lanres/article/PIIS2213-2...

nabla9 7y ago

The number of people dying on ventilators is not meaningful question because patient dying from COVID-19 almost always becomes critical before dying. If there is ventilator, they get hooked into them for a some time. The real question to ask is how many people who would survive with ventilator die without it.

enchiridion 7y ago
From a scientific perspective you are right. It is also important that people realize ventilators only have a moderate impact, and act accordingly.
alkonaut 7y ago
> because patient dying from COVID-19 almost always becomes critical before dying Actually I read the opposite. That the patients in ICU's are younger 40-70 with the bulk in their 60's, while those dying are mainly 75-100, mostly over 80 years old. That is: many if not most of those who die never pass the ICU. Obviously people in ICU wards die too, a significant fraction. But the age of the group that die mostly (80+) means it's mostly non-ICU patients. Doctors know a 80 year old with some comorbidity isn't going to survive being tubed. By "survive" they mean survive for X months afterwards too (This number can be e.g. 6 or 12 months to use as a guideline for survivability, to consider ICU treatment).
- outworlder 7y ago
  This is what makes discussions on this subject infuriating. Most people only have access to the absolute death numbers, and yet try to draw conclusions from them. If it is the case, as you say, that a significant fraction of young people need to go into intensive care to have a chance to recover, that makes this pandemic much worse than most people think. I do know that the number of hospitalizations is high (and possibly should be higher still, if hospitals were not turning away patients)
  - IgorPartola 7y ago
    Then here are the numbers: https://www.statista.com/chart/amp/21173/hospitalization-icu-admission-and-fatality-rates-for-reported-coronavirus-cases/ https://www.statista.com/chart/amp/21173/hospitalization-icu... COVID-19 still requires very high hospitalization rates, even among young people.

notyourday 7y ago

At +1 year post ventilator survival rate is 30% pre-COVID19 https://www.ncbi.nlm.nih.gov/pubmed/8404197 https://www.ncbi.nlm.nih.gov/pubmed/8404197

rladd 7y ago
To be more exact, (in that study) the total percentage of patients who were initially put on the ventilator who survived for at least a year was 30%. Of the approximately 50% of patients who were on a ventilator and survived long enough to be released from the hospital, 60% of those survived for at least a year.

paulmd 7y ago

Yes. 86% globally, 70% from Seattle currently at the moment. Here's a report on the state of things from a New Orleans ER doctor: https://www.reddit.com/r/medicalschool/comments/fpwc1y/frontline_covid19_experience_in_new_orleans_er/ https://www.reddit.com/r/medicalschool/comments/fpwc1y/front...